EARLY POSTOPERATIVE PHASE

GOALS:
A. Provide comfort, relief of pain and postoperative fever.
Causes of Postop fever:
ONSET ETIOLO TYPE TEST PHYSIC INTERVE COMPLI
GY FINDING AL NTIONS CATION
S FINDING S
S
st
Within 1 Atelectasi Low- Abn. Diminish Cough, Pneumon
24 H s grade CXR ed lung deep ia
sounds,ta breathe
chypnea
Days 2-3 Dehydrati Varies Hct, Uo, thirst, IV/PO Renal &
on SpG skin resp
turgor, comp.
dry skin
Days 3-5 Wound Varies +bld Pain, Antibiotic Sepsis,
infection cultures, redness, s wound
WBC swelling, dehiscen
suspiciou ce
s
drainage
at wound
site
Days 5-8 UTI Low- WBC, Urinary antibiotic Sepsis
grade +bld. frequenc s
cultures y,
urgency,
burning
Days 7- Thrombo Varies Pain, Out of Loss of
14 phlebitis swelling, bed as limb,seps
redness tolerated is,pulmon
@ site, ary
+Homan’ embolism
s sign

B. Promote wound healing.

Wounds are Classified as:
a. incised – clean cut
b. contused – blunt force
c. lacerated – jagged, irregular edges
d. punctured – bullet, knifestab
Types of Wound Healing:
a. First intention (PRIMARY UNION)
- occurs when wounds are created aseptically, with a
minimum tissue destruction and postop tissue reaction.

b. Secondary intention (GRANULATION)

- characterized by tissue loss with inability to approximate
wound edges.
- scarring is extensive
- healing process is longer

c. Tertiary Healing (DELAYED PRIMARY CLOSURE)

- healing process takes place when approximation of wound
edges is delayed by 3 to 5 days or more after injury or surgery.
- results in a deeper & wider scar

Factors that Affect Wound Healing:

1. age
2. nutrition
3. circulation
4. endocrine function
5. infection
 Purposes of Dressing:
1. To absorb drainage.
2. For splinting or immobilization of wound.
3. Protect wound from mechanical injury.
4. To prevent contamination.
5. For mental and physical comfort of the patient.

Basic Principles Involving Changing of Dressing:

1. Should almost always be completely changed when its outer
layer becomes saturated.

2. Tell the patient in advance, if possible, when you plan to change

his dressings.

3. Check the NCP to see what supplies you’ll need for changing
the dressing, or if the patient has been premedicated for pain.

4. Tell the patient what you are about to do.

5. Ensure privacy, good lighting, and make the patient comfortable.

6. When you remove the old dressing, pull the tape straight toward
the wound to minimize shearing and traction on the wound’s edges.
 7. Apply a new dressing that is :
large enough to cover and protect the wound
loose enough to promote air circulation
secure enough so it does not move

8. If you are dressing multiple wounds that are close together, apply
separate dressings.

9. Place all soiled dressings in separate container and remove

them from the patient’s environment as soon as you have
completed changing the dressing.

10. Document the wound’s appearance in the nurse’s notes.

C. Maintain fluid and electrolyte balance

D. Urinary output resumes normal pattern

E. Bowel patterns are reestablished

F. Activity is carried out within acceptable limits.

Benefits of early ambulation:

 1. increase in rate and depth of breathing improve ventilation and prevent
atelectasis and hypostatic pneumonia.

2. CO increases and improves circulation.

3. decreases venous stasis.

4. kidney function is increased due to improved circulation.

5. prevents occurrence of pressure sores

6. metabolism increases, muscles regain tone

7. peristalsis is stimulated

8. pain is decreased over time

9. morale is uplifted

G. Complications are prevented

Most common post-operative complications:
1. Hypostatic pneumonia
2. Infection
3. Shock
4. Decubitus ulcer
5. Hiccups
6. Thrombophlebitis